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PubMed1979

A study of hysterectomy in a family practice.

This paper reports on a study of women in a family practice who have undergone hysterectomy as compared with a group of matched controls. Significant differences were found in the greater number of major surgical procedures (other than hysterectomy) and the reporting of chronic and recurrent symptoms for the study group. Study group women were also found to have a greater number of identified intrapersonal and family problems. There was no significant difference, however, in the number of identified chronic organic problems. Differences which did not reach statistical significance suggest that women in the study group may be more likely to be living without a male partner, to be using long-term medication, and to be smokers. A most important finding was that the group of women who had undergone hysterectomy had also had 2.6 times the number of major surgical operations than the controls, excluding the hysterectomy. There were no differences between the two groups with respect to a number of other factors studied, eg, education, religion, history of psychiatric admission, obesity.

Adult↗

PubMed1975

A systems approach to patient care, curriculum, and research in family practice.

The system of data recording and retrieval which defines a family practice population of patients is described. It is organized at two levels, as a series of manual instruments or as a single instrument used as data input to a computer. Depending on resources available, it is possible to record demographic and morbidity data from the patient populations of both teaching and nonteaching practices. Data have been collected from a patient population of 88,000 in 26 practicing sites in Virginia, totaling 380,000 diagnostic and follow-up visits. Presentations are made of some of this data. The costs of this recording process in nonteaching practices, the use of such data as an educational resource for the training of primary care physicians, and the evaluations of health care delivered are discussed.

Curriculum↗

PubMed1988

Family practice physicians' perceptions of the usefulness of drug therapy recommendations from clinical pharmacists.

Family practice physicians' perceptions of the usefulness and clinical outcome of drug therapy recommendations made by clinical pharmacists in a family medicine clinic were determined. For 15 weeks, pharmacists in the clinic recorded all consultations in which they made recommendations about the drug therapy of specific patients. At the time of each consultation, the pharmacists gave the physician a questionnaire designed to gauge the physician's opinion of the usefulness of the consultation. Physicians who implemented the recommendations were sent a second questionnaire and asked to indicate the extent to which the clinical pharmacist influenced their decision to implement the recommendation, the effect the recommendation had on the patient's clinical status, and the usefulness of the recommendation to the patient in ways unrelated to clinical status (such as greater patient acceptance, safety, or lower cost). Five clinical pharmacists provided 59 consultations to 33 physicians. The physicians rated 51 (88%) of the consultations as very useful, and they implemented 78 (98%) of the 80 recommended actions. Of the 56 physicians who attributed their decision to implement the recommendation to their consultation with the clinical pharmacist, 43 believed that the recommendations had improved the clinical status of the patient, and 38 believed that the recommendations were useful to patients in ways unrelated to clinical status. Physicians in a family medicine residency training program had positive perceptions of the usefulness of drug therapy recommendations made by clinical pharmacists. A majority of the physicians believed that the recommendations had a positive effect on patients' clinical status.

Attitude of Health Personnel↗

PubMedDate not supplied

A national survey of vasectomy training in family practice residency programs.

To investigate the prevalence of vasectomy training in family practice residencies, a national survey of program directors was undertaken, with a response rate of 93%. Of the respondents, 44% had specific residency programs to provide vasectomy training. Of the residencies with specific training programs, training was a requirement in 18%. A majority of programs with training (54%) had both lecture and surgery components, with the remainder having only surgery. In 45% of the programs with training, residents performed five or fewer vasectomies, and in only 22% of the programs did residents perform more than 10 vasectomies. Among the programs where training was elective, 63% of the residents took the training. Only one program reported a medicolegal problem, which resulted in an out-of-court settlement.

Family Practice↗

PubMedDate not supplied

Immunization education among family practice residency programs.

BACKGROUND AND OBJECTIVES: The dynamic nature of immunization schedules, shortages, and administration techniques makes keeping up to date with current national recommendations difficult and necessitates periodic evaluation of immunization teaching resources. METHODS: This study surveyed family practice residency program directors in 1998 to assess their satisfaction with immunization teaching resources and interest in new resources. Subsequently, with funding from the Centers for Disease Control and Prevention, the Society of Teachers of Family Medicine Group on Immunization Education developed a series of educational materials devoted to educating family physicians about immunizations. In 2001, residency directors were surveyed again to evaluate the educational resources. RESULTS: Most program directors reported satisfaction with resources currently available to them for teaching residents about childhood immunizations, but about half (41% in 1998 versus 55% in 2001) agreed that keeping up to date on childhood immunizations was difficult. The corresponding figures for adult immunizations were 27% in 1998 and 36% in 2001. Pocket-size immunization schedules were ranked highly important (53% in 1998 versus 45% in 2001). Many would use handheld computer immunization schedules (53%). Although satisfaction with available resources did not increase following introduction of a newly developed journal supplement and Web site, the limited response received was favorable. CONCLUSIONS: Immunization teaching materials developed by family physicians, especially those that make use of evolving technologies, can be useful resources for individuals teaching family practice residents and for keeping up to date on recommendations for immunizations.

Family Practice↗

PubMed1986

Stressful life events and depressive symptomatology in obstetric patients: a pilot study in a family practice setting.

Several studies have found the presence of stressful life events to be associated with the appearance of postpartum depression. However, many of these previous studies have been conducted in obstetric clinics; relatively little research in this area has been done in a family practice setting. The first objective of this study was to note the prevalence of depressive symptomatology in a family practice clinic's pregnant patients. The second purpose was to evaluate the relationship between stressful life events and depressive symptomatology during pregnancy and the postpartum period. Each subject (n = 27) was given a Beck Depression Inventory (BDI) at three times: second trimester, third trimester, and three weeks postpartum. Each subject also completed a life events scale for obstetric patients after delivery; both weighted and unweighted life events scores were calculated. The correlation between the weighted and unweighted life events scores was 0.85. Postpartum BDI scores were significantly related to life events scores: 0.47 (n = 27, p = .0133) for unweighted scores and 0.58 (n = 27, p = .0015) for weighted scores. Weighted life events scores were more highly correlated with BDI scores at each of the three administration. Finally, 19% of these subjects showed BDI scores consistent with mild depression after delivery. Each of these results is consistent with findings from studies done in other settings.

Adult↗

PubMed1999

Assessing the need for faculty development in women's health among internal medicine and family practice teaching faculty. The Women's Health Education Working Group (WHEWG).

Women's health education is an emerging interdisciplinary field that has recently received national attention. The American Board of Internal Medicine and the American Academy of Family Practice recently have published competencies in women's health for their residents, with increased attention to gynecological and mental health issues. Increasing women's health in the curricula of internal medicine (IM) and family practice (FP) residents will certainly require faculty development among IM and FP teaching faculty. We report a multiinstitution needs assessment among IM and FP teaching faculty for continuing medical education (CME) in multidisciplinary women's health topics. The survey (n = 100) asked whether faculty desired CME in 30 women's health topics. It also requested rates of referral to specialists for breast and menstrual problems and performance of tests commonly carried out in the care of women (e.g., endometrial biopsy, colposcopy, skin biopsy, and sigmoidoscopy) as measures of possible need for CME. Of the 69 respondents, 37% were IM physicians and 63% were FP physicians. Among the 30 women's health topics listed, breast cancer treatment alternatives, infertility for primary care providers, cervical dysplasia, medical treatment in pregnancy, vulvar disease, indications for pelvic ultrasound/endometrial biopsy, and menstrual disorders were of highest interest. The ranking of desirability of topics by IM and FP faculty correlated by .54 (Spearman rank, df = 28, p < 0.01). Analysis of variance revealed a significantly higher interest overall by IM than FP physicians, 58% vs. 42% (F = 4.1, df = 1, 50, p < 0.05). None of the IM teaching faculty performed endometrial biopsy or colposcopy compared with 57% of FP physicians, and only 12.5% of internists performed skin biopsy and sigmoidoscopy compared with 70% of FP physicians (F = 33, df = 1, 38, p < 0.001). We conclude that faculty development in women's health would benefit resident training in IM and FP, and topics of interest are identifiable. The correlation in interests between the IM and FP teaching faculty might make joint programs successful, although gynecological skills and knowledge clearly are needed more by IM teaching faculty. Obstetrics and gynecology (OB/GYN) faculty could be instrumental in improving women's health education among their IM and FP colleagues.

Education, Medical, Continuing↗

PubMed1999

Issues in end-of-life care: family practice faculty perceptions.

BACKGROUND: Issues in end-of-life care in the United States are receiving increasing discussion in light of the aging population and the documented need to improve the quality of care for dying patients and their families. Family practice faculty are in a key position to contribute valuable information, given their missions to model necessary values, attitudes, and skills and directly teach quality end-of-life care. METHODS: We conducted interviews with 20 family practice faculty members in 3 residencies, and verbatim transcripts were coded by the authors. We held a second round of 12 interviews in 3 different residencies to check validity and expand the themes emerging from the original interviews. Corrected and elaborated themes were presented to focus groups from 2 other residencies. RESULTS: Themes of reaching consensus; establishing a treatment plan; mobilizing a caregiving system; dealing with relationships with patients, families, and the treatment team; and issues of personal domain were described as important in end-of-life care. CONCLUSIONS: The discussion of quality end-of-life care and how to provide it emphasized traditional medical concerns of diagnosis and prognosis, treatment, and caregiver support. Opportunities for innovation and improvement exist within the less explored areas of the relationship between the provider, patient, and family, and issues of personal meaning and experience.

Adult↗

PubMed1997

Attitudes of family practice residency program directors toward mandatory preemployment drug testing.

BACKGROUND AND OBJECTIVES: As health care institutions adopt policies on substance use and abuse and mandatory substance abuse testing in the workplace, applicants for house staff positions may become the subjects of testing as a requirement for acceptance into a residency program. This study attempted to learn what directors of family practice residency programs feel about mandatory preemployment drug testing and its effect on house staff recruitment. METHODS: We surveyed the directors of 420 US family practice residency programs, as listed by the American Academy of Family Physicians, in November 1994. All programs (community based, university affiliated, university based, and military) were included in the survey. RESULTS: A total of 308 (73%) program directors responded. Of these, almost half disagreed with mandatory substance abuse testing and felt it should not be a condition of acceptance for a house staff position. Eighty-eight percent believed that the existence of a policy did not hinder recruitment. None felt it was an enhancement. CONCLUSIONS: Preemployment drug testing for potential house staff remains a controversial issue, and it is unlikely that it will be universally implemented in the near future.

Attitude of Health Personnel↗

PubMed1993

No longer destined to eat their young: satisfaction among Army family practice faculty.

In January 1987, all 63 faculty members at Army Family Practice Residencies received satisfaction questionnaires. Fifty-nine faculty (93.8%) responded with 40 (67.8%) being satisfied and 19 (32.2%) dissatisfied. Compared to faculty 7 years prior, these faculty are slightly older, have more practice experience, more opportunities for fellowship training, and are less likely both to have remaining mandatory military obligation and to leave the Army after 3 years. The key areas of faculty development, control over professional life, administration, and departmental goals and objectives truly discriminated satisfaction from dissatisfaction. A strategy to systematically develop potential faculty and reduce dissatisfaction is proposed.

Faculty, Medical↗

PubMed1997

Drug samples and family practice residents.

OBJECTIVE: To describe residents' knowledge, attitudes, and behaviors regarding sample medications and to determine the education provided in residency training regarding sample use. METHODS: A 6-item survey was sent to directors of US family practice residency programs. Residents of a sample of these programs were sent an anonymous, self-administered, 21-item questionnaire assessing knowledge, attitudes, and practices relating to sample use. Both surveys consisted of initial and follow-up mailings. RESULTS: The residency directors' survey was returned by 232 of the 436 residency directors (53%). Although 66% of the programs had a policy regarding samples, only 15% of the policies completely incorporated recommendations of the Society of Teachers of Family Medicine. After two mailings, 248 resident responses were received from 43 of 47 residencies (92%). Only 21% of respondents thought that they received adequate training about sample use in medical school; this number increased to 49% for residency training. Agreement with the adequate training statement was highest among respondents from residencies that had both a sample distribution policy and a pharmacist (p = 0.044). Fifty-five percent thought that samples influenced their prescribing and 70% thought that samples helped them to learn more about the sampled medication. CONCLUSIONS: Family practice residents value and use samples, although they are often unaware of the rules governing the labeling of samples. While reported distribution of samples by residents often is appropriate, education about effective sample use could be improved. Drug samples play a significant role in residency training.

Adult↗

PubMed2001

Positive impact of rural academic family practices on rural medical recruitment and retention in South Australia.

Difficulty recruiting and retaining doctors in rural and remote Australia is well recognised. Here, we describe the positive impact on recruitment and retention of general practitioners of a network of university-linked rural family practices in South Australia. Between August 1995 and October 1999, 17 doctors were recruited; eight (47%) were female and six (35%) worked part time. Four doctors left the practices after an average of 20 months service (annual turnover of 6%). Of the two general practice registrars placed in the single accredited practice, one has since joined the practice and the other will do so in 2000. Five doctors are overseas-trained (24%) and four are expected to stay permanently. Rural academic family practices have successfully recruited and retained medical staff in this setting over the past few years. This model of practice may be a useful recruitment and retention strategy for other parts of Australia.

Academic Medical Centers↗

PubMed1981

Children as patients: a communications process study in family practice.

To determine how family physicians divide their attention between children and parents, 115 videotaped pediatric encounters of children (aged 4 to 14 years) and parents with family physicians in a family medicine center were analyzed. It was learned that physicians tended to involve children actively in the diagnostic stages of interviews but much less so in discussions of treating or dealing with their problems. Physicians did not alter this pattern as they advanced in training. Older children were more likely to receive direct communication from physicians in all phases of office encounters. Though the family physicians in this sample had more direct communication with children than reported in previous research, it is argued that greater involvement of children in all phases of pediatric visits is warranted. A developmental framework indicates that children gradually evolve their attitudes, concepts, and behaviors around illness and health. Family physicians and family medicine programs are in an excellent position to explore and utilize the practice of actively incorporating a child in a medical interview.

Adolescent↗

PubMed1991

A survey of resident orientation in family practice residency programs.

A questionnaire about orientations was mailed to all family practice residency program directors in the United States. One hundred percent of respondents indicated their residency had an orientation, ranging from less than one day to more than two weeks. More than 85% of the residencies had limited or no patient care involvement during orientation. Important orientation goals were to meet faculty, staff, and residents and to develop camaraderie. Most residencies evaluated their orientations. There were several significant differences in orientation programs based on characteristics of the residencies.

Family Practice↗

PubMed2000

Patients' smoking status: the family practice physician's view.

BACKGROUND: Smoking rates have decreased in western countries as well as in Israel during the past 20 years. OBJECTIVES: To estimate current rates of smoking and smoking cessation, and to assess factors associated with smoking and smoking cessation in family practice. METHODS: Prospective face-to-face interviews were conducted with 1,094 subjects, aged 16 years or older, registered in a family practice. RESULTS: Of all subjects studied, 746 (68.2%) were nonsmokers, 237 (21.7%) were current smokers, and 111 (10.1%) had stopped smoking. Overall, 31.8% of the males and 13.8% of the females were current smokers, and 20.1% males and 2.4% females had stopped smoking. Current smoking and smoking cessation rates were significantly and inversely associated with age among males and females. Smoking rates were higher among males and females who were married, had 10-12 years of education, and among males of North African origin and females of Israeli origin. The number of cigarettes smoked per day was associated with smoking and smoking cessation in males, but not in females. The highest rate of quitting occurred among males who smoked > or = 25 cigarettes per day. In a multiple regression analysis, gender and the number of cigarettes smoked per day were the most significant factors that predicted smoking cessation. The most common reason for stopping was the appearance of new signs of illness or the development of a new chronic disease, followed by a physician's recommendation to quit smoking. CONCLUSIONS: Female smokers and male smokers who smoke less than 25 cigarettes per day are the least likely to quit smoking. Future programs should be designed for and targeted at these groups of patients.

Adolescent↗

PubMed1999

Results of the 1999 National Resident Matching Program: family practice.

The 1999 National Resident Matching Program (NRMP) results reflect continued volatility in the perceptions and career choices of physicians entering graduate medical education in the United States. A total of 117 fewer positions (155 fewer US seniors) were filled in family practice residency programs in 1999, as well as 23 fewer (29 fewer US seniors) in primary care internal medicine and 38 fewer (27 fewer US seniors) in internal medicine-pediatric programs. In contrast, nine more positions (19 more US seniors) were filled in anesthesiology and one more (10 more US seniors) in diagnostic radiology, two "marker" disciplines that have recently been market sensitive. Seventy-three more positions (but 67 fewer US seniors) were also filled in categorical internal medicine, while 30 more positions (40 more US seniors) were filled in categorical pediatrics programs, where trainees are "pluripotential" with perceived options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the demands of managed care and the needs of rural and underserved populations continue to offer a market for family physicians, family practice experienced a second year of "primary care backlash" through the 1999 NRMP. In addition, current forces appear to be influencing some students to choose subspecialty rather than primary care careers.

Career Choice↗

PubMed1994

Fluoxetine in family practice patients.

BACKGROUND: Many patients with depression are seen only by family physicians, yet it is unknown how their physicians prescribe newer antidepressants. METHODS: Charts of family practice patients receiving fluoxetine were reviewed using a standardized format. Information reviewed included patient demographics, diagnosis, prescriptions, and course of treatment. RESULTS: Depression was documented in 92.5% of the 40 patients studied. There were significantly more female patients in the fluoxetine sample than in the base sample of depressed patients (P < .04). Fluoxetine patients weighed significantly more than the base sample, with a mean difference of 20.8 pounds (P < .03). Side effects were documented in the charts of 12 (30%) patients. Prescription practice was considered optimal in 43% of patients who were told to take fluoxetine in the morning. No differences in improvement or side effects were found based on optimal prescribing behavior. Improvement was documented in 68% of patients. Fluoxetine was discontinued in 6 (15%) cases because of adverse side effects. CONCLUSIONS: An improvement rate of 68% among patients taking 20 to 40 mg of fluoxetine per day indicates that an adequate response can be achieved without the risk of side effects that typically accompany higher doses. In this study, fluoxetine was prescribed more often to obese patients. This prescribing pattern may indicate that primary care physicians perceive overweight patients as good candidates for fluoxetine regardless of inconclusive evidence about the effectiveness of this drug for weight loss.

Adolescent↗

PubMed1978

Behavioral medicine in family practice: a unifying approach for the assessment and treatment of psychosocial problems.

Assessment and treatment of the varied psychosocial problems which affect patient health often present primary care physicians with their most difficult and frustating problems. This paper outlines criteria which can be used to select a model of psychosocial treatment compatible with an active family practice clinic. It also describes one treatment model which fits the criteria and can be used to assess and treat a wide range of psychosocial problems common to family practice.

Behavior Therapy↗